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Acute laminitis –acute treatment

And then?

Ove Wattle

Laminitis?

Cushings

Hoof abscess

bruising

MetritisEMS

Fracture

Myositis

Behandling av fång

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To treat laminitis

• As good recovery as possible

• The horse shall be as comfortable as possible during treatment

• Treatment should be practical

• a reasonable price

Goal

• Treat underlying causes• ”Box rest”• paraffinum liquidium p.o.• Pain controle• NSAID + …….?• Feeding regime• feed forage high• Biomechanical adjustment

Prostaglandins, leukotriener, interleukiner, bradykinin, substanse P, TNF-alfa contribute to increasedneurogenic sensitization and pain

Acute laminitis ≤72 hours from first clinical signs

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Treat underlying causes and laminitis

The horse should be comfortable

NSAID

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Primary inflammatory pain arising from peripheral tissues can be amplified by central secondary hyperalgesia and by neuropathic pain, both characterised by increased pre- and post synaptic neuronal sensitivity and activity at the level of the spinal cord

Pentoxifylline, which have anti-hyperalgesic properties via inhibition of the cytokines tumour necrosis factor (TNF) and interleukin-1 (IL-1) and matrix metalloproteinases, 8.8 mg/kg bwt per os q. 8 hDutton et al. Equine vet. Educ. (2009)

Gabapentin, an anti-seizure drug, for treatment of neuropathic pain, 2.5 mg/kg, PO, q 12 h - to - 3.3 mg/kg bwt per os q. 8 h.

Buthorphanol, Metadone

Williams et al. [2010] intravenous lidocaine had no effect on systemic and lamellar inflammation in fact there was some evidence of a pro-inflammatory effect.

Guedes et al. Vet Anaesth Analg. 2013

Treatment of pain associated with equine laminitis with soluble epoxide hydrolase (sEH) inhibitor, t-TUCB

Epoxidation of arachidonic acid by cytochrome P450 enzymes during inflammation yields epoxyeicosatrienoic acids (EETs). The EETs levels are regulated by soluble epoxide hydrolase (sEH).

Treat the right malady

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It is better to prevent than to treat- identify of horses at risk.

- Eliminate risk factors where possible or intervene therapeutically before establishment of the disease.

- In systemically ill horses, signs of sepsis or endotoxaemia are an established risk factor for laminitis and therefore aggressive therapy aimed at binding circulating endotoxin (polymixin B, plasma) and controlling systemic inflammation (nonsteroidal anti-inflammatory drugs, pentoxifylline) is rational.

- Continuous cryotherapy of the feet in these cases may prevent or at least ameliorate laminitis

Experimental cryotherapy 

10.0

20.0

30.0

Chris PollittAndrew van Eps

Horse with laminitis

< 5°C

50 % reduction of metabolism per10 °C ↓

Experimental cryotherapyresults

Chris PollittAndrew van Eps

550 SKrhttp://www.mantorpstravshop.se/

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Factors that might raise the baseline: Previous episode(s) of laminitis, gut flora, deworming, certain feed, hoof trimming/shoeing, transport, metritis, pulmonary-/intestinal-/kidney- diseases, medicines (ex. Cortisone), EMS, PPID, inactivity, endotoxin,

Strength

Clinical symtoms of laminitis

Normal hoof In gallop forces of up to 3 times the horse’s body weight

4 kg oligofructoseraise the baseline

Force, standing horse

Time

To get as good success rate as possible:

Treat underlying disease, and the rest above.“Mild laminitis” rest from work 2 – 3 months“ Rotation or sinking” rest from work 9-10 moths

Let them be without NSAID for 2 -3 days before lighten the restrictions.

Successive changes in feeding regime and other factors that can affect the gut flora, work, etc.

A good farrier and the right OWNER

When do westop treatment?

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Amplified/Exaggerated pulses in the digital arteries

Deficit in coronary band support

Laminitic “ring”

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Sinker

Rotation + sinking

Sinker

Rotation + sinking

Foal “ring”

”Growth rings” mainly due to change in feeding

Laminitic ring caused by dislocation of PIII

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A quick rotationGives a double sole

A slow rotation

Hovben

P III

Dropped sole; ≥ 2 days

Double sole; 3 – 5 weeks

Double sole

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Nort Swedish horse, Obelgrad 3, omproved but 4-5 weeks later Obel grade 4

14 days

When P III penetratesthe sole =Infectios osteitis

PIII infectious osteitis

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PIII infectious osteitis

White line

White line

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5 minutes and a hoof trim

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29 a

12 s

26 s

an

gio

gra

phy

Venous Arteries

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A. Parks, SE O`GradyVet Clin Equine pract2003. Strategi för Verkning/skoning avKroniska fånghästar

Treat the right malady

Hollow wall

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EMS – forskning vid SLU

Foto: Josefin Söder

Pågående och kommande aktiviteter:

• Patientmottagning vid UDS

• Fortsatt utvärdering av oralt glukostoleranstest (OGT)

• Karaktärisering av hästar med EMS

• Behandlingsutvärdering av EMS

• Hemsida för veterinärer (jan 2014) – www.hästmetabolism.se

Johan Bröjer, Sanna Lindåse, Katarina Nostell, kliniska vetenskaper, SLU

Oralt glukostoleranstest (OGT)

Foto: Josefin Söder

• Anpassat för Sverige

• Dynamisk test för IR men ett enda prov krävs

Teknik

• Hästen fastar from kl 22.00 dagen innan

• Uppskatta vikten enligt http://www.hastsverige.se/sida418.html

• Djurägaren ger Dan Sukker glykossirap (0,2 ml/kg) nästa morgon

• Veterinär tar blodprov 60 – 90 min senare

Oralt glukostoleranstest (OGT)

Foto: Josefin Söder

• Ta blodprov i serum‐ eller heparinrör

• Skicka serum eller plasma till klinisk kemi UDS (speciell remiss)

Tolkning av insulinkoncentrationer efter 60 – 90 min: (http://www.slu.se/sv/universitetsdjursjukhuset/klinisk‐kemiska‐laboratoriet)

• Normal: < 400 ng/L

• Gråzon: 400‐700 ng/L

• Insulinresistent: > 700 ng/L

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Thank You for Your attention!